Background: Depression is common among individuals of childbearing age, particularly during the perinatal period. Although suicide rates tend to be lower among those who are pregnant, potential risk factors of maternal suicide need to be better understood. The goal of this study was to examine demographic and psychosocial factors, including pregnancy and postpartum status and perinatal loss (eg, stillbirth, abortion) associated with suicide among a large diverse sample of childbearing-age individuals.
Methods: The study sample was obtained from 9 health systems in the Mental Health Research Network. This study used a case-control study design, with 290 childbearing-age individuals who died by suicide (cases) during 2000–2015 each matched to 10 childbearing-age individuals from the same health system and enrolled during the same time period who did not die by suicide (n=2900). Conditional logistic regression was used to investigate the relationship between pregnancy/postpartum status and suicide death in this matched case-control study.
Results: Childbearing-age individuals who died by suicide were more likely to have mental health disorder diagnoses including substance use disorders (adjusted odds ratio [aOR]: 2.69, 95% CI: 1.69, 4.26) and more likely to have visited the emergency department in the year prior to index date (ie, date of suicide death) (aOR: 3.44, 95% CI: 2.50, 4.73). Childbearing-age individuals who were pregnant (aOR: 0.14, 95% CI: 0.03, 0.63) or gave birth (aOR: 0.38, 95% CI: 0.16, 0.87) within a year before the index date had a lower risk of dying by suicide compared to individuals who had not experienced any pregnancy events. However, individuals who experienced perinatal loss were more likely to die by suicide (aOR: 1.43, 95% CI: 0.51, 4.00), although due to the small number of patients with this event (n=6 cases, n=21 control), the result was not statistically significant.
Conclusion: While pregnancy and delivery may be protective against suicide, perinatal loss may be associated with higher suicide rate. Routine screening and monitoring for anxiety, depression, substance use disorders, and prior emergency department encounters among individuals who experience pregnancy loss is warranted given their increased risk for suicide. Future studies should further examine associations between type of perinatal loss (eg, early infant
eath, miscarriage, abortion, stillbirth) and suicide mortality.